Stage 2 Mesothelioma

Stage 2 mesothelioma describes cancer that is still contained in one area of the body, but has spread outside the tissue lining the lungs or stomach and into nearby lymph nodes. Stage 2 is still considered an early stage of the disease, and most life-extending surgeries can still be performed. At this stage, patients usually have mild, flu-like symptoms or no symptoms at all, making stage 2 diagnoses rare.

What Is Stage 2 Mesothelioma?

Stage 2 malignant mesothelioma is the second earliest of the four stages of mesothelioma under the tumor-node-metastasis (TNM) staging system. The TNM system is the standard for cancer staging (a method for measuring how far someone’s cancer has progressed) in many countries.

Stage 2 mesothelioma may refer to two types of mesothelioma:

  • Pleural mesothelioma: Pleural mesothelioma is the only form of this rare cancer with an official staging system. Doctors use the TNM staging system, describing stage 2 pleural mesothelioma as remaining on one side of the lining of the chest. It has reached nearby lymph nodes on one side of the body and may have spread to the diaphragm or the lung.
  • Peritoneal mesothelioma: Some doctors may also categorize peritoneal mesothelioma as stage 2 using an unofficial, modified TNM staging system. This system, proposed by Professor Tristan D. Yan, describes stage 2 peritoneal mesothelioma as advancing further than the lining of the abdomen. However, the cancer has not spread past the abdomen or reached the lymph nodes.

Doctors currently do not have sufficient information about pericardial mesothelioma to properly stage it, instead often referring to its progression as early or advanced.

Quick Facts About Stage 2 Mesothelioma

  • Data from the National Cancer Institute (NCI) shows that roughly 16% of mesothelioma patients are diagnosed during the regional stage, which mainly corresponds to stage 2 and stage 3 mesothelioma.
  • According to NCI data, nearly 12% of patients with a regional mesothelioma diagnosis survive at least 5 years after diagnosis. For advanced-stage patients, this number drops to 8%.
  • According to a report by Professor Tristan D. Yan, survival rates for stage 2 peritoneal mesothelioma are similar to those of stage 1.

How Stage 2 Mesothelioma Develops

According to the Centers for Disease Control and Prevention (CDC), mesothelioma may take anywhere from 20-50 years to develop. However, once symptoms appear, the disease progresses rapidly.

Stage 2 mesothelioma progresses from stage 1 mesothelioma.

The TNM system describes stage 2 pleural mesothelioma tumor development as:

  • In the lining of the chest wall on one side of the chest
  • Possibly also in the diaphragm or the lung
  • In nearby lymph nodes on the same side of the body as the main tumor
  • Not yet spread to distant parts of the body

As mesothelioma progresses from stage 1 to stage 2, patients are more likely to begin experiencing minor symptoms.

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Stage 2 Mesothelioma Symptoms

Many mesothelioma patients do not notice any symptoms during stage 1 or stage 2 of their illness. When they do experience mesothelioma symptoms, they are often caused by a condition known as pleural effusion (fluid buildup in the chest).

Patients may experience the following stage 2 pleural mesothelioma symptoms:

  • Dry, persistent cough
  • Mild chest pain
  • Tightening in the chest
  • Shortness of breath
  • Slight difficulty breathing
  • Unexpected weight loss

Symptoms at this stage are caused by increased fluid buildup in the pleura, which leads to pressure and swelling in the chest and lungs In later stages, the pleural fluid hardens, causing more advanced and painful symptoms in the chest.

However, these symptoms are vague, and unless the patient has told their doctor about a history of asbestos exposure, such symptoms are unlikely to lead to a direct mesothelioma diagnosis.

How to Identify Stage 2 Mesothelioma

It is difficult to recognize stage 2 mesothelioma without diagnostic tools. Patients have vague symptoms that are common in other less serious illnesses such as the flu and pneumonia.

Early-stage mesothelioma is more likely to be discovered by accident in the course of unrelated medical tests or as part of regular cancer screening for a high-risk patient.

Because stage 2 mesothelioma symptoms are subtle, they can be confused with respiratory conditions such as pneumonia or Chronic Obstructive Pulmonary Disorder (COPD). This can lead to an initial misdiagnosis.

However, doctors are more likely to successfully diagnose a patient early if they know about any past exposure to asbestos. Discuss your past history of asbestos exposure with your doctor to prevent a life-threatening misdiagnosis.

Stage 2 Mesothelioma Diagnosis

Mesothelioma is not commonly diagnosed at stage 2 because patients often do not experience symptoms or their symptoms are mild and vague.

Doctors often struggle to diagnose mesothelioma at any stage, as most have minimal experience with the rare disease. Also, it is difficult to collect enough tissue from a patient for the many tests needed to tell mesothelioma apart from similar cancers.

Still, stage 2 malignant mesothelioma is easier to detect than stage 1 because of the tumor’s larger size and the increased likelihood that patients will experience pleural effusion.

If either of these signs shows up in a chest X-ray, doctors may investigate further, performing a biopsy that may lead to an early diagnosis.

Stage 2 Diagnosis and Staging Systems

Upon diagnosis, doctors use a staging system to find out how far a patient’s mesothelioma has advanced and what the outlook for their disease is.

The TNM staging system is the most widely accepted staging system for pleural mesothelioma, although other systems exist. These systems focus on different aspects of mesothelioma and all have their own way of describing stage 2.

Stage 2 Pleural Mesothelioma Diagnosis by Staging System

  • Butchart System: The cancer remains in the chest wall or has spread further into the chest.
  • Brigham System: Visible parts of the tumor can be completely removed through surgery. The cancer has spread to the lymph nodes.
  • TNM System: The cancer is in the lining of the chest wall and the lymph nodes on one side of the body. It may have spread to the diaphragm and lungs as well, but it has not reached distant parts of the body.

The Butchart system is still popular in some countries, but many doctors consider the TNM staging system the most practical in terms of understanding a patient’s prognosis.

Stage 2 Mesothelioma Prognosis

Doctors use the stage of a patient’s disease at diagnosis to determine their mesothelioma prognosis, which is how the cancer is expected to progress.

Mesothelioma is an aggressive form of cancer with a poor overall prognosis. Typically, the earlier the stage though, the better the prognosis might be.

Stage 2 mesothelioma has a good prognosis because it has not yet spread enough to prevent surgical treatments from being effective. Survival rates are much better when the mesothelioma remains isolated to one side of the chest.

Stage 2 Mesothelioma Life Expectancy

Mesothelioma life expectancy is the average amount of time, often measured in months, that a patient is expected to live after diagnosis.

According to a mesothelioma review published in West Virginia Medical Journal, the average survival time for malignant mesothelioma is 6-13 months overall and 6-18 months with treatment. Stage 2 patients can expect to live on the higher end of this range.

Stage 2 Mesothelioma Survival Rate

The mesothelioma survival rate measures the percentage of people with the disease who survive for a specified amount of time.

Stage 2 mesothelioma patients experience higher than average survival rates for both pleural and peritoneal mesothelioma.

A 2017 study published in Lung Cancer International collected data from over 11,000 pleural and peritoneal mesothelioma patients between 1973–2011 to show how a person’s stage at diagnosis affects survival rates.

The study used language from the older LRD staging system to describe pleural and peritoneal mesothelioma stages:

  • Localized: Stage 1 mesothelioma
  • Regional: Stage 2, 3, and 4 mesothelioma that has not spread to distant body parts
  • Distant: Stage 4 mesothelioma that has spread to other parts of the body

The tables below show the percentage of mesothelioma patients out of the entire study who lived for at least 1 year or 5 years, respectively, after diagnosis.

Survival Rates for Pleural Mesothelioma by Stage

Mesothelioma Stage1-Year Survival Rate5-Year Survival Rate

Survival Rates for Peritoneal Mesothelioma by Stage

Mesothelioma Stage1-Year Survival Rate5-Year Survival Rate

A patient’s mesothelioma stage at diagnosis is one of the biggest factors influencing their disease outlook. Stage 1 and 2 mesothelioma tumors are often resectable (surgically removable), allowing patients to undergo the most effective treatment options and increase their life expectancy by months or even years.

Stage 2 Mesothelioma Treatment

Because stage 2 mesothelioma has only spread a limited amount, many treatment options will work for patients. These include curative surgery, chemotherapy, and radiation. All three of these combined have proven to significantly extend life expectancy in this stage.

Curative surgery options for stage 2 mesothelioma are the same as stage 1. These surgeries are either a pleurectomy with decortication (P/D) or an extrapleural pneumonectomy (EPP).

Doctors may pursue one type of surgery over another, depending on how the mesothelioma has spread. With a P/D, surgeons remove the pleura and as much of the tumor as possible. With an EPP, surgeons remove whole and partial parts of the chest including the lung linings, one lung, the heart covering, and part of the diaphragm.

Doctors will also use chemotherapy and/or radiation therapy either before or after surgical procedures to help kill cancer cells, which supports the success of the surgery.

The optimal mesothelioma treatment approach for many stage 2 patients is a combination of surgery, chemotherapy, and radiation therapy.


Stage 2 mesothelioma is usually able to be surgically removed so that no visible parts of the tumor remain. By undergoing mesothelioma surgery, patients can extend their lives by months or even years and increase the effectiveness of other treatments like chemotherapy.

Patients who receive surgery during stage 2 have a life expectancy of 12 to 18 months, but many patients survive two years or longer after diagnosis. The fact that there are effective treatment options provides stage 2 mesothelioma patients with the hope that they can extend their life expectancy.

However, not all stage 2 patients are good candidates for surgery.

Doctors may consider the following factors to decide if a patient can undergo surgery:

  • Stage: Small, localized (contained in one area) tumors are easier to surgically remove.
  • Cell type: Unfortunately, only epithelioid and mixed/biphasic cell tumors are resectable.
  • Location: If a tumor is too close to a vital organ, it may be too dangerous to surgically remove it.
  • Patient health: Mesothelioma surgery is often dangerous and very hard on a patient’s body. Doctors will carefully assess a patient’s health to determine how likely they are to survive or properly recover from an operation.

If a patient is a good surgery candidate, they have a few options depending on the type of mesothelioma they have and a doctor’s individual assessment.

Common stage 2 mesothelioma surgery options include:

  • Extrapleural pneumonectomy (EPP)
  • Pleurectomy with decortication (P/D)
  • Cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC)

While surgery can remove a good deal of the mesothelioma tumors in a patient’s body, cancer cells remain that a surgeon cannot see. However, these cells may be destroyed with chemotherapy and radiation therapy.


Chemotherapy, cancer-killing medicines that are given intravenously, is a popular treatment option for stage 2 mesothelioma patients, especially combined with surgery.

Doctors may use chemotherapy on stage 2 mesothelioma patients to:

  • Stop cancer cells from spreading before, during, or after surgery
  • Destroy any cancer cells doctors cannot surgically remove
  • Treat patients who are not medically fit for surgery

While mesothelioma chemotherapy and surgery is often an effective treatment combination during stage 2, a three-treatment approach of surgery, chemotherapy, and radiation may lead to the best results for both pleural and peritoneal mesothelioma patients.

Radiation Therapy

Radiation therapy uses beams of intense energy to kill cancer cells. This treatment is an important part of the multi-treatment approach many doctors turn to for stage 2 mesothelioma.

Radiation therapy may help treat stage 2 mesothelioma by:

  • Killing cells that remain after surgery
  • Making surgery easier by shrinking tumors beforehand
  • Keeping doctors from accidentally spreading cancer cells during surgery

While a three-treatment approach works well for many stage 2 mesothelioma patients, other treatment options are available for the many who are not able to get standard treatment.

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Other Treatment Options

Stage 2 mesothelioma patients are usually good candidates for the most effective standard treatments. However, factors like mesothelioma cell type and individual health may bar even early-stage patients from undergoing such invasive treatments.

For these patients, experimental treatments through clinical trials may be a good option. Clinical trials test the newest medicines and therapies in an effort to improve or expand current treatment options.

Emerging mesothelioma treatments may include:

  • Anti-angiogenesis
  • Gene therapy
  • Immunotherapy
  • Photodynamic therapy

Patients should keep the stage of their mesothelioma in mind when searching for clinical trials. Many trials restrict patients by cancer stage.

Improving Your Stage 2 Mesothelioma Prognosis

While the biggest factors affecting stage 2 mesothelioma prognosis are often out of a patient’s control, they can still take action to give themselves the best prognosis possible.

The following actions may improve a stage 2 mesothelioma prognosis:

  • Eating well: Nutrition is essential for a strong immune system and a quick and complete recovery after invasive treatments like surgery and chemotherapy.
  • Exercising: Exercise has several health benefits, including lowering stress, improving blood flow, and helping prevent secondary health issues like bedsores.
  • Managing stress: Stress can negatively affect health by increasing blood pressure, causing sleep problems, and other issues. This may slow treatment recovery and decrease quality of life.
  • Not smoking: Smoking negatively affects overall patient health and may even disqualify a patient from certain treatments. It may also increase the chance of another cancer diagnosis, such as lung cancer.
  • Seeking life-extending treatment: For many mesothelioma patients, life-extending treatments are simply not an option because their cancer is already too advanced. However, stage 2 patients are often good candidates for such treatments.

Stage 2 mesothelioma patients should take advantage of their early diagnosis and seek life-extending treatments as soon as possible.

Hopefully, as new studies shed light on better treatment methods, mesothelioma patients at all stages will continue to see their survival rates increase.

Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Mesothelioma Hope was founded by a team of advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. We help give hope to those impacted by mesothelioma.

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